Predictive factors for adrenal metastasis in extra‐adrenal malignancy patients with solitary adrenal mass

Byeon, Kyeong-Hyeon; Ha, Yun‐Sok; Choi, Seock Hwan; Kim, Bum Soo; Kim, Hyun Tae; Yoo, Eun Sang; Kwon, Tae Gyun; Lee, Jun Nyung; Kim, Tae‐Hwan

doi:10.1002/jso.25272

Cited by 8 publications

(11 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our previous study revealed that malignant and functional tumors are not rare in patients with adrenal incidentaloma and that a history of other cancers is not associated with adrenal malignancy [16]. Byeon et al and colleagues demonstrated that high pre-contrast HU, male sex, and metachronous adrenal mass were associated with malignant adrenal lesions, which was similar to the results of our study [17]. However, this finding is far from perfect, and fine needle aspiration could be a reliable examination method for selected patients, although there is a potential risk of hypertensive crisis [10].…”

Section: Discussionsupporting

confidence: 91%

A clinicopathological analysis of adrenal tumors in patients with history of extra-adrenal cancers

Tan

Xiao

et al. 2019

BMC Cancer

View full text Add to dashboard Cite

Background Adrenal tumors in patients with previous/synchronous extra-adrenal malignancy are diverse and are a dilemma in clinical practice. This study investigated the differentiation of adrenal malignant and benign tumors in these patients. Methods Data from patients with a pathological diagnosis of adrenal tumors were retrospectively retrieved from April 1991 to November 2015. Patients without extra-adrenal malignancy were excluded. Clinical and imaging characteristics, including sex, age, tumor size, tumor location, isolated lesion, time interval between the diagnosis of the two tumors and retrieved imaging diagnosis, were collected and analyzed. The selected patients were divided into 2 groups: those with primary or secondary malignancies (PSM) and those with primary benign tumors (PB). Chi-squared tests were used to evaluate differences between the two groups. Logistic regression was performed to explore potential risk factors related to the differentiation of PSM and PB, and a receiver operating characteristic (ROC) curve was used to evaluate their diagnostic values. Results Ninety-one patients were selected; 54 were male, and the median age was 56 years old. Between the groups of PSM and PB, sex ( p = 0.004), age ( p = 0.029), tumor size ( p < 0.001), isolated lesion ( p < 0.001) and imaging diagnosis ( p < 0.001) were significantly different, while tumor size ( p = 0.001), sex ( p = 0.047) and imaging diagnosis ( p = 0.002) were independent predictors of PSM. With ROC curve analysis, risk factors ≥2 was the optimal cutoff to differentiate these adrenal tumors, and their sensitivity and specificity were 73 and 77%, respectively. With a median follow-up of 32 months, only 4 of 32 patients with PB died from cancer, and 24 of 47 patients with PSM died from cancer, although aggressive treatment was performed. Conclusions Tumor size, sex and imaging diagnosis were independent predictors of adrenal primary or secondary malignancies. These predictors might be helpful for differentiation of adrenal tumors in patients with previous/synchronous extra-adrenal cancers.

show abstract

Section: Discussionsupporting

confidence: 91%

A clinicopathological analysis of adrenal tumors in patients with history of extra-adrenal cancers

Tan

Xiao

et al. 2019

BMC Cancer

View full text Add to dashboard Cite

show abstract

“…While adrenal metastases from different organs and different histological type of cancers are well-known and frequent, isolated metastases from breast cancer are very rare and the knowledge of their biological behavior is limited to a few isolated case reports ( 1 , 8 ). Among different histologic types, invasive ductal carcinoma, the most common of breast cancers, should be less likely to be associated with distant and especially adrenal metstases ( 8 , 11 – 13 ), as opposed to invasive lobular carcinoma, which is less frequent but more aggressive ( 8 ).…”

Section: Discussionmentioning

confidence: 99%

“…The adrenal gland is a relatively frequent site of metastasis due to its rich sinusoidal blood supply (1,2). Metastases most often occur from lung, renal and gastrointestinal cancer (3)(4)(5)(6)(7), with squamous cell carcinoma and adenocarcinoma being the most commonly encountered histological diagnoses (1). In contrast, adrenal metastases from breast cancer account for only 2.9% of all adrenal metastases and are most often associated with synchronous metastases at other extraadrenal sites (8).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Results of Adrenalectomy for Isolated, Metachronous Metastasis of Breast Cancer: A Retrospective Cohort Study

et al. 2021

View full text Add to dashboard Cite

Background and Aim: Metachronous, isolated adrenal metastases from breast cancer are extremely rare. The aim of this study was to evaluate the results of adrenalectomy as a treatment of this uncommon condition.Methods: Twelve female patients (median age: 68 years) underwent 13 adrenalectomies for isolated, metachronous metastases of breast cancer. Ten resections were performed thorugh open surgery and two were preformed through a laparoscopic approach. As main study endpoints, postoperative mortality, postoperative morbidity and disease-free survival were considered. Median length of follow-up was 40 months.Results: Postoperative mortality was absent. Postoperative morbidity was 17%: one patient presented a postoperative pneumothorax requiring drainage and one patient required re-hospitalization 8 days after contralateral adrenalectomy for electrolyte imbalance. Two patients died of recurrent metastatic disease, 28 and 33 months respectively after adrenalectomy. One patient remained alive with hepatic metastases at 32 months from resection of adrenal recurrence. All in all, disease-free survival at 48 months was 75%.Conclusions: Adrenalectomy for metachronous, isolated metastases of breast cancer can be performed with no postoperative mortality and minimal postoperative morbidity, enabling good long-term disease-free survival.

show abstract

“…The reasons for adrenal gland lesions presenting as sanctuary sites are not clear. The simplistic explanation appears to be that the tumor microenvironment of glucocorticoids within adrenal cortex maybe responsible for development of immune-resistant metastases ( 19 ). The immunosuppressive milieu is likely to prevent tumor infiltration of lymphocytes (TIL), hence promoting progression of metastases ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

Adrenal Metastases as Sanctuary Sites in Advanced Renal Cancer

Vaishampayan

Shah

Asad

et al. 2020

jkcvhl

View full text Add to dashboard Cite

Involvement of the adrenal gland in kidney cancer represents a unique site of metastasis with a distinct clinical course. The cases are typically resistant to immune therapy and need local therapy management. A case series of patients with adrenal metastases was reviewed to highlight the nuances of clinical course and therapy. We reviewed renal cancer carcinoma (RCC) cases with adrenal metastases at Karmanos Cancer Center, Detroit MI. Medical records were reviewed to collect relevant case information. Next-generation sequencing, tumor mutation burden testing, and programmed death ligand biomarkers were evaluated in five cases. Twelve cases were reviewed; all were males with a median age of 49.5 years. Three patients presented with adrenal metastases only and were treated with local therapy. Three received interleukin-2 (IL-2). One patient relapsed with bilateral adrenal lesions after 11 years of remission, post-IL-2 therapy. Five cases received immune checkpoint inhibitor (ICI) and one received antivascular therapy. ICI therapy was followed by ablation of residual adrenal metastases in three patients. Genomic profiling was available in five cases. All were BAP1 and PD-L1 negative. Pathogenic mutations in PBRM1, SETD2, and VHL were noted. All patients with residual adrenal metastases responded to antivascular therapies or to local ablation. One patient died 17 years after diagnosis and 11 patients are alive at a median follow-up of 9.5 years. Adrenal metastases in RCC have a distinct clinical course. They can represent a sanctuary site of relapse/residual disease following treatment with immune therapy. Management with local therapy can induce durable remissions. Systemic management with antivascular therapies also demonstrated favorable responses. Further investigation should focus on the unique clinical course and optimal management of adrenal metastases in kidney cancer.

show abstract

Predictive factors for adrenal metastasis in extra‐adrenal malignancy patients with solitary adrenal mass

Cited by 8 publications

References 36 publications

A clinicopathological analysis of adrenal tumors in patients with history of extra-adrenal cancers

A clinicopathological analysis of adrenal tumors in patients with history of extra-adrenal cancers

Results of Adrenalectomy for Isolated, Metachronous Metastasis of Breast Cancer: A Retrospective Cohort Study

Adrenal Metastases as Sanctuary Sites in Advanced Renal Cancer

Contact Info

Product

Resources

About